Provider Demographics
NPI:1588915029
Name:GRIMBLE, FELICIA RENEICE
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:RENEICE
Last Name:GRIMBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4753 NEWBY HALL CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2361
Mailing Address - Country:US
Mailing Address - Phone:702-688-1953
Mailing Address - Fax:702-369-5605
Practice Address - Street 1:4753 NEWBY HALL CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2361
Practice Address - Country:US
Practice Address - Phone:702-688-1953
Practice Address - Fax:702-369-5605
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner